"Natural Disasters " - April 2nd - Ballard Road Registration

Date of Birth *
Date of Birth
Parent Name *
Parent Name
Parent Cell Phone *
Parent Cell Phone
Parent Home Phone *
Parent Home Phone
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone Number *
Emergency Contact Phone Number
The EYE Staff is American Red Cross CPR/AED/First Aide Certified
The EYE Saturday Program provides a free pizza lunch for all participants! To avoid wasting food, please check the appropriate box below.
Photo Release Consent *
I give consent for photos of my child taken at the EYE Saturday Program to be used in the promotion of further elementary engineering programs.
Is your family eligible for financial assistance? *
If paying for EYES is a hardship please check the appropriate box below and we will waive the entrance fee.